JMIR Publications

ABSTRACT

Background:

Digitizing Clock Drawing Test (dCDT) has been recently used as a more objective tool to assess cognition. However, the association between digitally obtained clock drawing features and structural neuroimaging measures has not been assessed in large population-based studies.

Objective:

We aimed to investigate the association between dCDT features and brain volume.

Methods:

This study included participants from the Framingham Heart Study who had both a dCDT and MRI scan who were free of dementia or stroke. Linear regression models were used to assess the association between 18 dCDT composite scores (derived from 105 dCDT raw features) and brain MRI measures, including total cerebral brain volume (TCBV), cerebral white matter volume, cerebral gray matter volume, hippocampal volume, and white matter hyperintensity (WMH) volume. Classification models were also built from clinical risk factors, dCDT composite scores, and MRI measures to distinguish people with mild cognitive impairment (MCI) from those who were cognitively intact.

Results:

A total of 1,656 participants were included in the current study (mean age 61±13 years, 50.9% women) with 23 participants diagnosed with MCI. All dCDT composite scores were associated with TCBV after adjusting for multiple testing (P value<0.05/18). Eleven dCDT composite scores were associated with cerebral white matter volume, but only one dCDT composite score was associated with cerebral gray matter volume. None of the dCDT composite scores was associated with hippocampal volume or WMH volume. The classification model for MCI versus NC participants incorporating age, sex, education, MRI measures, and dCDT composite scores reached the area under the curve (AUC) of 0.897.

Conclusions:

dCDT composite scores were significantly associated with multiple brain MRI measures in a large community-based cohort. The dCDT has potential to be used as cognitive assessment tool in the clinical diagnosis of MCI.